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Predictive factors for successful early prosthetic ambulation among lower-limb amputees
M C Munin1, M C Espejo-De Guzman, M L Boninger
1Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, PA 15213, USA. muninmc@msx.upmc.edu
Objective:
To predict successful prosthetic ambulation for patients immediately transferred to an inpatient rehabilitation facility after amputation surgery.
Methods:
Seventy-five individuals with lower-limb amputation were studied at a tertiary acute care and rehabilitation facility. Successful prosthetic ambulation, defined as the ability to ambulate with a prosthesis at least 45 m, was measured in addition to other key demographic and medical factors.
Results:
Sixty-eight percent were successful prosthetic ambulators at rehabilitation discharge. The absence of residual-limb contracture and a longer length of stay during rehabilitation showed a significant relationship to successful prosthetic ambulation with regression analysis. Younger age was modestly correlated to outcome. There were no significant differences when comparing success of the early rehabilitation program with surgical level or etiology of amputation. For successful prosthetic users, mean wear time at rehabilitation discharge was 5.7 hours with a mean distance walked of 67 m. Of those who failed this approach, 70% were related to a failure of wound healing.
Conclusions:
In this cohort, 68% of patients who were selected for a trial of early prosthetic rehabilitation ambulated using a prosthesis at rehabilitation discharge. This approach appears to be more effective for younger patients without contractures who are medically stable to participate in the rehabilitation process.